Factitious disorder imposed on another (FDIA) is a mental illness. It causes a person to fabricate illness in a dependent, leading to the dependent receiving unnecessary medical treatment. The person does not do this for financial gain.
The relationship is most likely to involve a mother and child, and FDIA usually stems from a maladaptive disorder or a need for attention.
Another type of factitious disorder is factitious disorder imposed on self (FDIS). A person with FDIS fabricates signs or symptoms of an illness in themselves.
FDIA is a mental health issue. A parent or caregiver with FDIA seeks medical care for a dependent person who does not need it.
The caregiver benefits by receiving praise for their devotion and by developing relationships with doctors and other healthcare workers.
Experts describe FDIA as “relatively rare” but often misdiagnosed. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) report that around 1% of people in hospitals may meet criteria of a factitious disorder.
A person with FDIA often has a history of mental health issues.
A doctor may suspect FDIA if a parent or caregiver repeatedly seeks medical treatment for a child or another dependent who has unexplained symptoms.
Below, find indications of FDIA.
In the caregiver:
- describing the illness in a way that does not match the doctor’s observations
- giving vague and inconsistent information about the dependent’s medical history
- accepting risky interventions without concern
- showing medical knowledge despite having no medical training
- repeatedly requesting further action
- seeking the attention and approval of healthcare workers
- having a history of mental health problems
- having a lack of social network or family
Around 10–25% of people with FDIA also induce symptoms in themselves.
In the dependent:
- showing atypical signs of a health condition
- having several illnesses
- having normal test results
- not responding to treatment
- experiencing symptoms only when the caregiver is present
- undergoing repeated hospitalizations and surgery
- having complications or new symptoms after a negative test result
- having few or no visitors and only one caregiver present
When a person with FDIA is responsible for symptoms or illnesses, these tend to include:
- food allergies
- gastrointestinal problems
- neurological disorders
- weight loss
- infections and fevers
- kidney problems
- urological problems
To avoid detection, the caregiver may change doctors frequently or take the dependent to various hospitals for treatment.
A person with FDIA may fabricate or induce an illness in various ways. For example, they may:
- invent signs and symptoms
- tamper with test results
- apply chemicals to the dependent’s skin to cause a rash or irritation
- use medications, such as laxatives, insulin, or psychoactive substances to trigger symptoms
- injure the dependent
- inject the dependent with feces to cause an abscess
The effects on the dependent can be long-lasting and include:
- missed school and other opportunities, due to multiple hospitalizations
- physical risk, due to unnecessary procedures and tests
- long-term mental health problems
The exact causes of FDIA are unclear, but experts believe that another mental illness or a past traumatic experience can play a role.
According to the DSM-5, FDIA may develop after the dependent has spent time in a hospital for a legitimate reason.
Also, some people with FDIA have experienced neglect, abuse, or other trauma during childhood, such as the loss of a family member.
In addition, there may be a history of unusual diseases in the person’s family or a history of relationships in which illness brought positive attention.
FDIA can be hard to detect because it is relatively uncommon and because doctors can usually expect caregivers to tell the truth.
The DSM-5 lists the following criteria for FDIA:
- falsifying signs or symptoms or inducing injury or disease in another person with the intention of deceiving
- presenting another person as having signs and symptoms of an illness
- receiving no external reward, such as financial gain.
- having no evidence of another condition, such as one that causes delusions
The physician will note how many times the person has displayed action consistent with FDIA.
If a doctor suspects FDIA, they may invite a team of experts, including physicians, psychologists, and child protection workers, to evaluate different aspects of the case.
They may also retest blood and urine samples to check for concrete indications of an illness and evidence of any added substances, such as blood in urine samples.
In addition, some hospitals have used video cameras to help confirm a diagnosis.
Various experts can provide treatment to the caregiver and the dependent.
Treatment may involve:
- psychotherapy and counseling
- family therapy
- physical therapy
For the caregiver
Psychotherapy can help the caregiver identify the reasons for their actions and how to resolve the problem. This may involve learning to form relationships that are not associated with illness.
Family therapy looks at family tensions and parenting skills and seeks to promote a healthy relationship between the child and the caregiver.
Effective treatment is usually possible once a person acknowledges that the problem exists. Treatment can be difficult if the person denies that they have FDIA.
For the dependent
A team will work with the dependent, who is usually a child, to restore their mental and physical health.
In extreme cases, the child must learn to live with vision loss, impaired mobility, brain damage, or similar challenges.
They may benefit from long-term counseling to deal with anxiety, trauma, and stress. They may also need to learn to form and maintain healthy relationships that do not involve being ill.
Other challenges may include catching up on missed schooling, developing social skills, and restoring other aspects of a child’s usual routine.
Experts suggest that the long-term outlook depends on how severe the damage is and how long it has taken doctors to identify FDIA.
Some people need lifelong treatment for mental health issues and support for physical challenges.
Experts also call upon doctors to be aware of the red flags, so that diagnosis can happen as early as possible.
Online forums can also provide support for survivors of abuse associated with FDIA.